Connected Health:

Using patient-centric technologies to change

behavior and improve outcomes

Joseph C. Kvedar, MDDirector

Center for Connected HealthPartners HealthCare

About the Center for Connected Health

• Division of Partners IS organization– Research and evaluation– Program development and rollout– Operational systems and support– Commercialization

• Our interest is in the use of technology to deliver care remotely:– Heart failure monitoring– Diabetic monitoring and coaching– Blood pressure self-management for large

employer

• Benefits include:– Increased patient engagement – Improved health outcomes– Improved patient-provider communications

Four Cornerstones of Connected Health

• Harness accurate physiologic and behavioral data• Engage patients to view and understand their health

information• Achieve care goals via data driven coaching• Leverage providers when needed

Connected Health is Patient Centered Care

Connected Cardiac Care

• Population: CHF

• Technology: Blood pressure, oximeter, weight, touch screen device

• Coaching: telemonitoring nurse

• Goal: decreased readmissions

• ROI:• Better bed management• Lower cost of care

Heart Failure Monitoring

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

Intervention Control

No

. o

f R

ead

m (

mea

n)

All cause

CHF

0.62

0.95

0.0

0.2

0.4

0.6

0.8

1.0

1.2

Prior to CCCP enrollment(point estimate and 95% C.I.)

Following CCCP disenrollment (point estimate and 95% C.I.)

Ho

sp

ita

liza

tio

n R

ate

pe

r p

ers

on

pe

r y

r

Total CHF Cases

1,600 Total Medicare CHF Cases

1,200

Total 30 Day Readmit CHF Cases

300

Impact to System:

Risk to System With no preventable readmissions

Revenue = $0

Direct Cost = $2M

Direct Margin = -$2M

By avoiding admissions could save up to $2M

Plus, backfill opportunity resulting from 300 avoided admissions ~$1.7M

30-Day Readmissions: CHF Monitoring Business Case

Provider Feedback

“This program has tremendous promise for improving the care for patients and potentially for improving access to office visits for new or other existing patients.

I have a patient who was enrolled in the program recently. She had been in my office or her cardiologist’s office just about weekly and now she is regularly monitored and managed from her home. As I result, I see her every six weeks and that has opened up appointment slots for other patients who need to get into see me.”

- Elizabeth Mort, MD, MGH

MD Refusal Rates

12%10%

5%

1%

2%

0%

2%

4%

6%

8%

10%

12%

14%

Q2FY08 Q3FY08 Q4FY08 Q1FY09 Q2FY09

MDRefusal

As MDs gain experience with the telemonitoring program, they are more likely to enroll their patients.

MD Refusal Rates

Connected Health Diabetes

• Population: Diabetics – requiring daily glucose readings

• Technology: glucometer, gateway, web interface

• Coaching: diabetes educator

• Goal: improved control

• Business justification:• Meet P4P targets• Decreased downstream

complications

Shila Hill, diabetes educator at BWH Newton Corner:

This program improves communication between the patient and provider.

I would recommend this program for any diabetes patient on insulin, for those who need their medications adjusted often, and for the newly diagnosed.”

Connected Health Diabetes

Diabetes Connect – Case studies

Sample - successful patient charts (weekly readings)

Over 80% of enrolled patients uploading data on a regular basis.

Connected Health Diabetes

Journal of Diabetes Science and Technology (Volume 3, Issue 2, March 2009)

Pilot Study conducted by the Center for Connected Health:

• Assessed patient & provider satisfaction, frequency of use and changes in glucose levels over a period of 3 months.

• Mean blood glucose range decreased in Month 3 vs Month 1 (141.1 and 146.5, respectively).

• Self-reported HbA1c fell from 6.8% at the start of the study to 5.8% at the end.

• Web application was well received by participants.

Evidence from other studies

MyCareTeam study – McMahon et al

Greater change in HbA1c over time in intervention group p <0.05

Cost of Diabetes/person/year

Hospital Inpatient

Nursing home

Physician office

Hospital Outpatient

Emergency

Ambulance services

OP Meds

Insulin and delivery supplies

Oral agents

Morbidity1

6309

2140

1525

489

366

23

797

579

414

Home health 516

Hospice 84

2971

991

695

215

187

11

341

579

414

190

39

Cost of days lost

Productivity2

521

Cost of non-work days lost

Sub-Total 13,242 6633

A1c>7.5 A1c<7.5

Potential savings/per person per year

531

1,052

$7,661

Source: American Diabetes Association

Sub-Total

Cost difference

6609

1052

Diabetes Monitoring ROI

Est. Cost of Diabetesrelated morbidity and productivityper year

$7,661,000

Est. Success Rateof Intervention 33%

Est. Cost of Intervention

$500,000

Est. Savings $2,528,024

For 1000 enrollees:

Return in Year 1

$2,028,024

5:1 ROI

Success Rate neededto cover cost of intervention:

7%

Remaining Challenges

• Cost reduction

• Patient identification

• Workforce optimization

• Program optimization

Conclusions

• Connected health is evolving as a new dimension in HIT.

• Patient behavior change is a critical goal.

• Monitoring increases engagement and improves coaching.

• Quality, access and efficiency are improved.

• Learn more: www.connected-health.org

LinkedIn group – Connected Health Community

Twitter - @jkvedar @connectedhealth